This lesson will explain why it is important for hospitals to develop technical evaluation and management (E/M) guidelines for reporting outpatient emergency department medical visits to the Centers for Medicare and Medicaid Services (CMS). Covered topics include: guidelines for reporting coverage and separately-reportable services use of modifiers specific requirements for types of services such as ED, clinic, or critical care visits definitions of Type A and Type B facilities explanation of excepted and non-excepted provider-based off-campus clinics
“This program has been approved for 0.50 continuing education unit(s) for use in fulfilling the continuing education requirements of the American Health Information Management Association (AHIMA). Granting prior approval from AHIMA does not constitute endorsement of the program content or its program sponsor.”
This activity is approved for 0.50 contact hours.
Section 1: Introduction
About This Course
Section 2: Hospital Internal Guidelines
AHA and AHIMA Recommended Guidelines
Models for Emergency Department E/M Technical Guidelines
Basics of Facility Guidelines
Distribution of Visits
Section 3: ED Type
Emergency Departments: Type A and Type B
Section 4: Visit Type
Packaged Critical Care Ancillary Services
Trauma Activation Payment
Section 5: Payment
Payment for Emergency Department and Clinic E/M Levels
Reporting Emergency Department E/M Levels
Services Included in Facility-Based Emergency Department E/M Guidelines
Separately Reportable (Billable) Procedures
Modifier -25 Reporting
Modifier -25 Example
Section 6: Telehealth Services
Section 7: Conclusion
Expert Reviewer: Richard R. Cooley, BA, CCS
Jean Russell has over thirty years of healthcare and information system experience. Her areas of expertise include the Medicare outpatient prospective payment systems (APCs, and APGs), as well as ICD-10-CM/PCS training, Charge Description Master (CDM), admission status reviews, and outpatient coding and compliance. She is a frequent speaker at the national, state and local levels for HFMA and AHIMA professional groups. Jean has her Masters from the University of Houston in Biomedical Engineering; her Bachelors from Colgate University in Biology; and her RHIT from the independent study program through the American Health Information Management Association.Disclosure: Jean C. Russell, MS, RHIT has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Instructor: Alison Kazmierczak
Richard has more than eighteen years in healthcare consulting. He has developed an expertise in hospital outpatient and inpatient coding, including professional split billing and E/M coding, admission criteria, reimbursement and compliance, and charge master reviews. His areas of expertise include Medicare reimbursement for the Medicare Outpatient Prospective Payment System (OPPS), Medicaid Ambulatory Payment Groups (APGs), as well as commercial payers, and professional reimbursement. He is a certified coder with AHIMA (CCS). Richard earned his Bachelors from Hobart College.Disclosure: Richard R. Cooley, BA, CCS has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
Alison has twenty-nine years of healthcare and information system experience, eleven of those years consulting at hospitals across the United States. Her areas of expertise include all aspects of Soarian Financials Revenue Management including Service Catalog (CDM), Service Maps, CRDT, General Ledger, Contracts, Claims, Reports, and all Master Files. Alison has provided analysis and reconfiguration for optimization, new build services, legacy support for hospital systems moving to a new platform, and training.Disclosure: Alison Kazmierczak has declared that no conflict of interest, Relevant Financial Relationship or Relevant Non-Financial Relationship exists.
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